Andre Riddick Sr., LPCC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

288964 Issued in KY

Practice address

1301 Winchester Rd Ste 147
Lexington, KY 40505-4179

Phone

(859) 991-0710

Fax

(859) 309-1791

NPI assigned

Feb 15, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Group practices

LJKSGroup PAC ID 2769895374, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• TN PPO C-SNP
• devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
• OH PPO
• KY PPO C-SNP
• TN PPO
• KY PPO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• LJKS

  • Professional Counselor
  • Lexington, KY
  • NPI 1194207910

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD
• Main Street Medical Associates

  • Family Medicine Physician
  • Morehead, KY
  • NPI 1003496902

  Addiction (Substance Use Disorder)

  NPD
• Commonwealth Behavioral Health & Counseling

  • Professional Counselor
  • Mt Sterling, KY
  • NPI 1780109827
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1003372905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 WINCHESTER RD STE 147",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405054179",
            "telephone_number": "859-991-0710",
            "fax_number": "859-309-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 WINCHESTER RD STE 147",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405054179",
            "telephone_number": "859-991-0710",
            "fax_number": "859-309-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDICK",
        "first_name": "ANDRE",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-02-15",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "KY",
            "license": "288964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Rickerson, RN, MSN, CDE
• Lee W Ricketts II, MD
• Rachel A Ridd, CSW
• Samantha Lee Riddell
• Sunny Christina Riddell
• Alicia Riddle
• Benjamin David Riddle
• Kaitlyn Ridenbaugh
• Emma Ridener
• Steven J Rider, DMD

• Counselor in Lexington, KY
• Providers in Lexington, KY by specialty
• Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.